Pharmacotherapy Services

The 21-member Pharmacotherapy Team employs highly-skilled Clinical Pharmacists who have completed a postgraduate Pharm.D. Degree with a pharmacotherapy specialty residency; a 6-year Pharm.D. Degree with 2 years of pharmacy residency training; or extensive equivalent experience.

Clinical Pharmacists specialize in all of the following settings: Critical Care, Surgery & Nutrition, Emergency Medicine, Internal Medicine, Infectious Diseases, Cardiology, Psychiatry, Geriatrics, Long-Term Care, Wound Care, Ambulatory Care, and Drug Information.

The department has four ASHP-accredited pharmacy residency programs. Three are specialty residency programs in Critical Care Pharmacotherapy, Geriatric Pharmacotherapy, and Internal Medicine. The Pharmacotherapy team is highly respected as an elite healthcare team.

Summary of Annual Pharmacotherapy Services Highlights

Clinical Pharmacy Service	Annual Highlights
Pharmacotherapy Services	Clinical Pharmacists perform > 30,000 pharmacotherapy interventions Pharmacotherapy interventions lead to > $6 million in costs savings
Restricted Antibiotic Consult Service	Clinical Pharmacists approve over 8,000 restricted antibiotics
Adverse Drug Events Consult Service	Over 800 ADEs are detected, reported, and managed
Pharmacokinetic Consult Service	Aminoglycoside and vancomycin orders require a Clinical Pharmacist’s review, written note, and follow up
Clinical Pharmacology Consult Service	Physicians request formal written pharmacotherapy consults
Ambulatory Care Services	Pharmacist-lead clinics are provided for anticoagulation (warfarin), diabetes, and smoking cessation
Ventilator Weaning Service	Pharmacotherapy interventions have helped decrease the length of stay by 2 – 3 days

Clinical Pharmacist’s & Pharmacy Resident's Prescribing Privileges

In the acute care facility, the Clinical Pharmacist may adjust parenteral medication orders in the Pharmacy Application based on patient’s renal and hepatic function, concomitant medications, and overall condition. In the long-term care facility, the Clinical Pharmacist may take medication orders from the prescriber and enter the order in the Pharmacy Application. Nursing will then execute the order. With a prescriber’s oral approval, Clinical Pharmacists may dose any drug and directly enter the medication order in the CPOE system. Unless a physician opts-out, Clinical Pharmacists can initiate an antimicrobial IV-to-PO conversion, and write such medication orders. Clinical Pharmacist privileges at KJMC have extended the Pharmacist’s scope of practice to allow for best practice and best care.